Medicare Support for Dental and Podiatry Graduate Medical Education Programs

ObjectiveThis study examines the individual, educational, and policy factors that predict dentists pursuing postgraduate dental (PGD) training.MethodsIndividual dentist records from the 2017 American Dental Association Masterfile were linked with pre‐doctoral training attributes and state‐level dental policy factors. Generalized logistic models, adjusted for individual, educational, and policy factors, were used to predict: (1) attending any PGD program, and (2) primary (i.e., advanced general practice, pediatrics, or dental public health, per the Health Resources and Services Administration [HRSA]) versus specialty care.ResultsThe majority of new PGD residency slots (77%) were in primary care. Women held 56% of primary care slots; men held 62% of specialty slots. Individual characteristics that predicted PGD primary care training included being Black, Hispanic, Asian, or other race; being male or older age reduced the odds. Pre‐doctoral school characteristics that predicted PGD primary care training included having a pre‐doctoral HRSA grant, affiliation with an academic medical center, and being a historically Black college/university; being a private school or in a small metro area lowered the odds. At the policy level, the strongest predictors of attending PGD primary care training are a residency requirement in the state you currently practice in and federal graduate medical education (GME) investment per residency slot.ConclusionPursuing PGD training is variable based on the race/ethnicity/gender of the dentist. Federal investments in pre‐doctoral dental education and GME can drive equity, as they significantly increase the odds that dentists will go on to PGD training, as do state licensure requirements.

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confidence: 87%

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confidence: 62%

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confidence: 99%

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confidence: 99%

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Trends in postgraduate dental training in the United States

Bates

Jura

Werts

et al. 2022

“…We used a curated database of graduate medical education (GME) funding data from the Centers for Medicare and Medicaid Services, 17 dental residency program data from the 2018–2019 ADA Survey of Advanced Dental Education, 15 and podiatric residency program data from the Central Application Service for Podiatric Residencies 18 to estimate the amount of GME funding per dental residency slot each state received in 2018. GME funding for dental residency training is bundled together with funding for podiatric medicine residency programs; how much money was allocated to each type of program in 2018 was unknown.…”

Section: Methodsmentioning

confidence: 99%

Practice patterns of postgraduate trained dentists in the United States

Mertz

Bates

Kottek

et al. 2022

ObjectivePostgraduate dental (PGD) primary care training has grown significantly. This study examines the individual, educational, community, and policy factors that predict practice patterns of PGD‐trained dentists.Study designIndividual dentist records from the 2017 American Dental Association Masterfile, with indicators of Medicaid participation and practice in a Federally Qualified Health Center (FQHC), were linked to postdoctoral training, community/practice location, and state policy factors. Generalized logistic models, adjusted for these factors, were used to predict PGD‐trained dentists: (1a) serving Medicaid children, (1b) accepting new Medicaid patients, and (2) working in an FQHC.ResultsIndividual attributes that predicted serving Medicaid children included all race/gender combinations (vs. White females), and foreign‐trained dentists and contractors/employees/associates (vs. practice owners). Black women are most likely to work in an FQHC. Residency attributes that predicted serving Medicaid children and working in an FQHC were Health Resources and Services Administration postdoctoral funding and being community based. Dentists practicing in rural or high‐poverty communities were more likely to serve Medicaid children and work at FQHCs. States with higher levels of graduate medical education investment, higher Medicaid rates, and more generous adult dental Medicaid benefits increased the likelihood of serving Medicaid children, while states with more expansive adult dental Medicaid benefits increased the likelihood of working in an FQHC.ConclusionFederal training investment in PGD education combined with Medicaid payment and coverage policies can strongly impact access to dental care for vulnerable populations. Yet, oral health equity cannot be achieved without increasing dentist workforce diversity.

Postgraduate education to expand access to dental care: A roadmap to community dental program development

Page

Koday

Zamierowski

et al. 2023

Evidence indicates an increasing shortage of dentists in communities across the United States with potentially significant implications for oral health, as well as overall health and well-being. One strategy to increase access to dental care in rural and underserved communities is community-based postgraduate dental training. However, developing new dental programs requires navigating complex accreditation, financial and community governance, among other, barriers. The Roadmap for Teaching Health Center Dental Program Development presents a framework that guides institutions through the successive steps of developing new postgraduate training programs from identification of need to ultimate maintenance and sustainability. The tool assists programs in anticipating and understanding requirements, reducing time, expense, and uncertainty. While the framework was developed for community-based programs, the steps are applicable to postgraduate programs sponsored by academic institutions as well.